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215 Chisholm Trl Jacksboro TX 76458 | |
| (940) 567-6633 | |
| (940) 567-2895 |
| Full Name | |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 215 Chisholm Trl, Jacksboro, Texas |
| Authorized Official Name and Position | Kim Lee (COO) |
| Authorized Official Contact | 9405676633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
215 Chisholm Trl Jacksboro TX 76458-1403 Ph: (940) 567-6633 | 215 Chisholm Trl Jacksboro TX 76458 Ph: (940) 567-6633 |
| NPI Number | 1790777696 |
|---|---|
| Provider Enumeration Date | 08/17/2005 |
| Last Update Date | 09/16/2021 |
| Medicare PECOS PAC ID | 5890768675 |
|---|---|
| Medicare Enrollment ID | O20040819000032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790777696 | NPI | - | NPPES |
| 119874903 | Medicaid | TX | |
| 119874904 | Medicaid | TX | |
| 119874905 | Medicaid | TX | |
| 119874902 | Medicaid | TX | |
| HH0054 | Other | TX | BC/BS PROVIDER NUMBER |
| Provider Name | Cynthia L Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659333060 PECOS PAC ID: 3072582105 Enrollment ID: I20040927000460 |
| Provider Name | Alfred A Santos |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518065937 PECOS PAC ID: 6305744822 Enrollment ID: I20041102000680 |
| Provider Name | John E Lockyer |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1306061346 PECOS PAC ID: 0749239671 Enrollment ID: I20050119000038 |
| Provider Name | Thomas E Steffen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083619092 PECOS PAC ID: 8729025044 Enrollment ID: I20050411000498 |
| Provider Name | Charles K Tibbels |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871569632 PECOS PAC ID: 9234176314 Enrollment ID: I20050411000514 |
| Provider Name | Jefferson B Alling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477558245 PECOS PAC ID: 5092752311 Enrollment ID: I20050411000527 |
| Provider Name | Shawn L White |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396764767 PECOS PAC ID: 9931144367 Enrollment ID: I20050801000458 |
| Provider Name | Jeffrey Scott Smith |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1295749877 PECOS PAC ID: 3971595208 Enrollment ID: I20070917000674 |
| Provider Name | Lisa J Lunsford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770770851 PECOS PAC ID: 2961584214 Enrollment ID: I20080125000516 |
| Provider Name | Delbert L Mccaig |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134189632 PECOS PAC ID: 6901841279 Enrollment ID: I20080606000560 |
| Provider Name | Jeremy W Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457521874 PECOS PAC ID: 7719047760 Enrollment ID: I20081120000130 |
| Provider Name | Susan Hansford-orsburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053417857 PECOS PAC ID: 7911902010 Enrollment ID: I20090519000395 |
| Provider Name | Sharon Gay Mclemore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750616801 PECOS PAC ID: 9436296191 Enrollment ID: I20091028000801 |
| Provider Name | Beryl A Brigham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477636009 PECOS PAC ID: 5890832562 Enrollment ID: I20091029000036 |
| Provider Name | Aaron G Purdy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750567228 PECOS PAC ID: 3173662848 Enrollment ID: I20091209000628 |
| Provider Name | Brent H Shepherd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164687620 PECOS PAC ID: 6901081314 Enrollment ID: I20110429000123 |
| Provider Name | Philip S Gafford |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1275743502 PECOS PAC ID: 8628248291 Enrollment ID: I20130911000032 |
| Provider Name | Cathy C Gresham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679902092 PECOS PAC ID: 1658509591 Enrollment ID: I20140122001166 |
| Provider Name | Joseph P Mozur |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255752622 PECOS PAC ID: 8224251533 Enrollment ID: I20140513002188 |
| Provider Name | Joshua M Evans |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376830539 PECOS PAC ID: 4688803109 Enrollment ID: I20140903001894 |
| Provider Name | Erika M Crutcher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578830402 PECOS PAC ID: 9335365881 Enrollment ID: I20141222000592 |
| Provider Name | John R Nuckols |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1528423365 PECOS PAC ID: 4789980483 Enrollment ID: I20160307001038 |
| Provider Name | Jason K Tibbels |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215904222 PECOS PAC ID: 0941285654 Enrollment ID: I20160330002291 |
| Provider Name | Leslie Michelle Hollis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1275582777 PECOS PAC ID: 3375827199 Enrollment ID: I20170222002638 |
| Provider Name | Shivum K Agarwal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700220738 PECOS PAC ID: 6305121294 Enrollment ID: I20170315001697 |
| Provider Name | Samantha C Purdy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114437290 PECOS PAC ID: 6709143027 Enrollment ID: I20171121003314 |
| Provider Name | Chelsea May Jutila |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1770059677 PECOS PAC ID: 7517204670 Enrollment ID: I20190128001283 |
| Provider Name | Jessica L Coker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386236164 PECOS PAC ID: 1456767045 Enrollment ID: I20210305000619 |
| Provider Name | Jessa C Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083226765 PECOS PAC ID: 1759797293 Enrollment ID: I20210309001441 |
| Provider Name | Lindsey Rene Maly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467962357 PECOS PAC ID: 5496132029 Enrollment ID: I20220519001500 |
| Provider Name | Katie Rae Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841908274 PECOS PAC ID: 0244604304 Enrollment ID: I20230314000198 |
| Provider Name | Ariel Ann-ski Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821794553 PECOS PAC ID: 8022476233 Enrollment ID: I20230621000519 |
| Provider Name | Christine Lashell Hopson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629757497 PECOS PAC ID: 7911351770 Enrollment ID: I20230927001971 |
| Provider Name | Hope Michelle Whitsitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295578813 PECOS PAC ID: 4082154521 Enrollment ID: I20240910004695 |
Robert Cooper, M.d., Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Chisholm Trl, Jacksboro, TX 76458 Phone: 940-567-5528 | |
Global Family Practice, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 215 Chisholm Trl, Jacksboro, TX 76458 Phone: 940-217-5969 | |
Physician Services Of Jacksboro Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 709 N 4th St, Jacksboro, TX 76458 Phone: 817-565-0922 | |
Lara Pierce, Md Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 217 W Belknap St, Jacksboro, TX 76458 Phone: 940-567-8114 Fax: 940-521-5511 | |
Sushil B. Chokshi, M.d., P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 217 W Belknap St, Jacksboro, TX 76458 Phone: 940-567-2101 Fax: 940-567-5522 |